Mechanisms of Acupuncture on the Neurovascular Unit in Migraine: A Narrative Review

The neurovascular unit (NVU) is a core structural and functional entity involved in migraine pathogenesis. Acupuncture may exert therapeutic effects by protecting NVU integrity. This narrative review aims to summarize the current evidence on the mechanisms by which acupuncture protects the NVU in migraine.

We reviewed and synthesized relevant literature focusing on the effects of acupuncture on neuronal excitation, blood-brain barrier (BBB) components, neuroinflammation, and energy metabolism in the context of migraine.

Acupuncture protects the NVU through four major pathways: (1) Acupuncture inhibits pathological excitation of neurons, including activating the endogenous pain regulation system, regulating the balance of neurotransmitters and receptors, and inhibiting peripheral sensitization and inflammation; (2) Acupuncture maintains the integrity of the BBB, specifically involving improving endothelial cell function and tight junctions (TJs), regulating astrocyte reactivity, enhancing pericyte function, and inhibiting extracellular matrix (ECM) degradation; (3) Acupuncture regulates neuroinflammation mediated by microglia; (4) Acupuncture improves energy metabolism and oxidative stress.

Acupuncture exerts multi-target, comprehensive protective effects on NVU damage in migraine. These findings provide a mechanistic basis for its clinical application and may offer new therapeutic directions for migraine management.